Neonatal resuscitation follows the ABC approach of clearing airways, initiating breathing, and maintaining circulation. It is performed for newborns who have difficulty transitioning after birth. Approximately 5-10% require active resuscitation. The guidelines outline steps including warming, suctioning, tactile stimulation, positive pressure ventilation, chest compressions, and medications like adrenaline if needed. Oxygen levels and heart rate are closely monitored during resuscitation efforts.

3.  Nelson Essentials of Pediatrics 21th edition
2022 .

4.  Series of actions, used to assist newborn who
have difficulty with making the physiological
‘transition’ from the intrauterine to extrauterine
life.
 Approximately 5-10% of newborns require
active resuscitation to prevent birth asphyxia.
 High-risk situations should be anticipated by
the hx of pregnancy, labor, and delivery .

5.  Neonatal resuscitation is generally follow the
basic rule (ABC) :-
 A: anticipate and establish patent airway by
suctioning and, if necessary, by performing
endotracheal intubation.
 B: initiate breathing by using tactile stimulation or
positive-pressure ventilation with bag and mask.
 C: maintain the circulation by chest compression
and medications.

7.  the 1-min Apgar score may signal the need for
immediate resuscitation.
The 5-, 10-, 15-, and 20-min scores may
indicate the probability of successfully
resuscitating an infant or not

8.  newborns with high apgar scores (>7) may
also need only the routine care by :-
 warm, dry the infant & clear his airway (if
needed By suctioning oro-pharyngeal and
nasal secretion by using suction catheter .
Introduce the catheter about 5cm into the mouth
and 3cm into the nose.

10.  Place the newborn warming (to prevent
hypothermia),
 supplemental oxygen, put the head down with
slight extension,
 clear the airway by suctioning and provide gentle
tactile stimulation (e.g. slapping the feet, rubbing
the back).
 These measures should take 30 sec, then reassess, if
apgar scores become higher, stop resuscitation,
whereas if still low shift to step 2 .

11.  Provide positive pressure ventilation through a
tightly fitted face mask and bag (ambu bag) with
continuous SPO2 monitoring by pulse oxymeter *.
 These measures should also take 30 sec, then
reassess,
 if apgar scores become higher, consider CPAP &
continue SPO2 monitoring till complete recovery.
 whereas if apgar scores are still low, shift to step 3.

12. Age SPO2
1 min 60-65%
2 min 65-70%
3 min 70-75%
4 min 75-80%
5 min 80-85%
10 min 85-95%
___________________________________
The American Heart Association
American Academy of Paediatrics .

13.  Provide positive pressure ventilation through
endotracheal tube (ET) *
 If HR <60 beat/min initiate chest compression over
the lower third of the sternum at a rate of 90/min &
the ventilation is 30/min with 100% O2 (i.e. ratio of
compression to ventilation 3:1) for 1 min then
reassess,
 if apgar scores become higher, consider CPAP with
continuous SPO2 monitoring till complete recovery,
whereas if still low, shift to step 4.

14.  The ET tube size & depth of insertion (from upper
lip) should be according to the birth weight as
follows:-
 BW (kg) Size (mm) Depth(cm)
 <1 2.5 6.5-7
 1-2 3 7-8
 2-3 3-3.5 8-9
 >3 3.5-4 ≥9
 ensure equal air entry in both lungs by auscultation
in the lateral or posterior aspect of chest .

15.  Give Adrenaline either through the umbilical vein
or via the ETT in a dose 0.1-0.3 ml/kg I.V or 0.5-1
mL/kg intratracheally .
 It can be repeated every 3-5 min if the newborn is
unresponsive.
 If adequate resuscitation continues for 10 min
without a detectable heart rate, it is reasonable to
stop resuscitative efforts.

16.  Before initiating drug treatment, one should check
the following:
› Whether the air way is open.
› Whether the chest inflates with each ventilation .
› Whether chest compression given properly.
› If the newborn does not respond even after the
airway is open the chest moves easily with
Ventilation , and effective chest compressions
has been given, only then the drugs may help.

17.  Volume expander :
when blood loss in known or suspected
(Pale skin, weak pulse, poor perfusion and heart
rate not responding adequately to the
other resuscitative measures) .
an isotonic crystalloid solution or blood 10ml/kg is
recommended which may need to be repeated.
 Volume expanders should be infused very slowly
to the premature babies.
If infused rapidly that may cause hypertension &
Intra ventricular hemorrhage.

18.  Intravenous glucose
administration should be considered as soon as after
resuscitation with the goal of avoiding hypoglycemia.
 Sodium bicarbonate:
Sodium bicarbonate is usually not useful during
the acute phase of neonatal resuscitation.
Without adequate ventilation and oxygenation it
will not improve the blood pH and may worsen
cerebral acidosis. After prolong resuscitation
sodium bicarbonate may useful in correcting
documented metabolic acidosis

20. Harmful Action Consequences
 Slapping the back  Bruising
 Squeezing the rib cage  Fractures
 Holding upside down
and shaking  Intraventricular
bleeding,
pneumothorax, death.